Lateral Rectal Dissection

• Draw the rectum to right side of pelvis and place left lateral peritoneum under tension. Identify left side of the rectum.
• Sharp and blunt dissect to define plane between ligaments and lateral mesorectum.
• Divide lateral ligaments by combining bipolar (Fenestrated Maryland Bipolar) and monopolar cautery (Monopolar Curved Scissors)
• Continue dissection along the left pelvic sidewall distally for several centimeters until levator ani muscle is exposed.
• Draw the rectum to left side of the pelvis to identify right lateral peritoneum and place it under tension.
• Repeat same dissection sequence as above for left side down to the level of the levator ani muscle.

1. Initial Exposure
2. Primary Vascular Control
3. Medial to Lateral Mobilization of Sigmoid & Descending Colon
4. Splenic Flexure Mobilization
5. Rectal Dissection & Division
• Posterior Dissection
• Lateral Dissection
• Anterior Dissection
• Rectal Division